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BRADFORD REGIONAL MEDICAL CENTER

Serum Protein Electrophorsesis


Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients
with multiple myeloma and other disorders of serum protein. The pattern of serum protein
electrophoresis results depends on the fractions of two major pes of protein: albumin and globulins.
Albumin, the major protein component of serum, is produced by the liver under normal physiologic
conditions. Globulins comprise a much smaller fraction of the total serum protein content. The
subsets of these proteins and their relative quantity are the primary focus of the interpretation of
serum protein electrophoresis. Figure 1 shows a typical normal pattern
for the distribution of proteins as determined by serum protein electrophoresis.

ALBUMIN
The albumin band represents the largest protein component of human serum. The albumin level is
decreased under circumstances in which there is less production of the protein by the liver or in which
there is increased loss or degradation of this protein. Malnutrition, significant liver disease, renal loss
(e.g., in nephrotic syndrome), hormone therapy, and pregnancy may account for a low albumin level.
Burns also may result in a low albumin level. Levels of albumin are increased in patients with a relative
reduction in serum water (e.g., dehydration).

ALPHA FRACTION
Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the
alpha1 and alpha2 components. The alpha1-protein fraction is comprised of alpha1-antitrypsin,
thyroid-binding globulin, and transcortin. Malignancy and acute inflammation (resulting from
acutephase reactants) can increase the alpha1- protein band. A decreased alpha1-protein band may
occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of
liver disease. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein
band. The alpha2 component is increased as an acute-phase reactant.

BETA FRACTION
The beta fraction has two peaks labeled beta1 and beta2. Beta1 is composed mostly of transferrin, and

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beta2 contains beta- poprotein. IgA, IgM, and sometimes IgG, along with complement proteins, also
can be identified in the beta fraction.

GAMMA FRACTION
Much of the clinical interest is focused on the gamma region of the serum protein spectrum because
immunoglobulins migrate to
this region. It should be noted that immunoglobulins often can be found throughout the
electrophoretic spectrum. C-reactive protein
(CRP) is located in the area between the beta and gamma components.

Indications
Serum protein electrophoresis commonly is performed when multiple myeloma is suspected. The
examination also should be considered in other “red flag” situations. If the examination is normal but
multiple myeloma, Waldenström’s macroglobulinemia, primary amyloidosis, or a related disorder still
is suspected, immunofixation also should be performed because this technique may be more
sensitive in identifying a small monoclonal (M) protein.

Interpretation of Results
Plasma protein levels display reasonably predictable changes in response to acute inflammation,
malignancy, trauma, necrosis, infarction, burns, and chemical injury. This so-called “acute-reaction
protein pattern” involves increases in fibrinogen, alpha1-antitrypsin, haptoglobin, ceruloplasmin, CRP,
the C3 portion of complement, and alpha1-acid glycoprotein. Often, there are associated decreases in
the albumin and transferrin levels. In the interpretation of serum protein electrophoresis, most
attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG
type. The gamma-globulin zone is Decreased in hypogammaglobulinemia and agammaglobulinemia.
Diseases that produce an increase in the gamma-globulin level include Hodgkin’s disease, malignant
lymphoma, chronic lymphocytic leukemia, granulomatous diseases, connective tissue diseases, liver
diseases, multiple myeloma, Waldenström’s macroglobulinemia, and amyloidosis. Although many
conditions can cause an increase in the gamma region, several disease states cause a homogeneous
spike-like peak in a focal region of the gamma-globulin zone (Figure 2). These so-called “monoclonal
gammopathies” constitute a group of disorders that are characterized by proliferation of a single
clone of plasma cells that produce a homogeneous M protein.

Oct 2007

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